Improving Outcomes in the Treatment of Obesity via Practice-Based Evidence: Weight Loss, Nutrition, and Work Productivity

Obesity is a large and growing problem in the United States and elsewhere. Data gathered by the National Center for Health Statistics indicate that 33% Americans are obese. When overweight people are added to the mix, the figure climbs to a staggering 66%! The problem is not likely to go away soon or on its own as the same figures apply to children.

Researchers estimate that weight problems are responsible for over 300,000 deaths annually and account for 12% of healthcare costs or 100 billion–that’s right, $100,000,000,000–in the United States alone. The overweight and obese have higher incidences of arthritis, breast cancer, heart disease, colorectal cancer, diabetes, endometrial cancer, gallbladder disease, hypertension, liver disease, back pain, sleeping problems, and stroke–not to mention the tremendous emotional, relational, and social costs. The data are clear: the overweight are the target of discrimination in education, healthcare, and employment. A study by Brownell and Puhl (2003), for example, found that: (1) a significant percentage of healthcare professionals admit to feeling “repulsed” by obese person, even among those who specialize in bariatric treatment; (2) parents provide less college support to their overweight compared to “thin” children; and (3) 87% of obese individuals reported that weight prevented them from being hired for a job.

Sadly, available evidence indicates that while weight problems are “among the easiest conditions to recognize,” they remain one of the “most difficult to treat.” Weight loss programs abound. When was the last time you watched television and didn’t see an ad for a diet pill, program, or exercise machine? Many work. Few, however, lead to lasting change.

What might help?

More than a decade ago, I met Dr. Paul Faulkner, the founder and then Chief Executive Officer of Resources for Living (RFL), an innovative employee assistance program located in Austin, Texas. I was teaching a week-long course on outcome-informed work at the Cape Cod Institute in Eastham, Massachusetts. Paul had long searched for a way of improving outcomes and service delivery that could simultaneously be used to provide evidence of the value of treatment to purchasers–in the case of RFL, the large, multinational companies that were paying him to manage their employee assistance programs. Thus began a long relationship between me and the management and clinical staff of RFL. I was in Austin, Texas dozens of times providing training and consultation as well as setting up the original ORS/SRS feedback system known as ALERT, which is still in use at the organization today. All of the original reliability, validity, norming, and response trajectories were done together with the crew at RFL.

Along the way, RFL expanded services to disease management, including depression, chronic obstructive pulmonary disease, diabetes, and obesity. The “weight management” program delivered coaching and nutritional consultation via the telephone informed by ongoing measurement of outcomes and the therapeutic alliance using the SRS and ORS. The results are impressive. The study by Ryan Sorrell, a clinician and researcher at RFL, not only found that the program and feedback led to weight loss, but also significant improvements in distress, health eating behaviors (70%), exercise (65%), and presenteeism on the job (64%)–the latter being critical to the employers paying for the service.

Such research adds to the growing body of literature documenting the importance of “practice-based” evidence, making clear that finding the “right” or “evidence-based” approach for obesity (or any problem for that matter) is less important than finding out “what works” for each person in need of help. With challenging, “life-style” problems, this means using ongoing feedback to inform whatever services may be deemed appropriate or necessary. Doing so not only leads to better outcomes, but also provides real-time, real-world evidence of return on investment for those footing the bill.

Comments

Scott,
First off, I’m a big fan of the SRS & ORS (I believe it’s particularly helpful for the therapist who is empathically challenged. It’s like telling such therapists “Here say thus at the begining and this at the end – it’ll give your patient the impression that you actually give a damn”)

But… the impressive results are compared to what. I have little doubt that the outcome was a result of the SRS & ORS. But for the “non-believers” why not enhance the face validity by noting controls were used. I would imagine that the research study included the elements necessary for scientific research. So, tell us so, or leave the skeptics doubting.
Thanks -bernie

As you say, “finding the “right” or “evidence-based” approach for obesity (or any problem for that matter) is less important than finding out “what works” for each person in need of help.” I look forward to reading about the measurement of outcomes–we CAN affect–and the therapeutic alliance using the SRS and ORS aligned with Health At Every Size® principles:

Scott, you are not accurate in reporting most of your obesity facts. But the main problem in what you are reporting is that any intervention to change weight has to have 2-5 year data before we can say that it is any different from the endless examples of weight cycling that have come before it. The 2-5 year window is the time when almost everyone regains weight and a significant number end up heavier. Anyone making evidence-based claims needs to have that data, on everyone who started the intervention – otherwise you are merely restating the obvious that weight loss is temporarily possible, but nearly always temporary.

The facts are: for most groups in the US, obesity rates stopped rising 5-10 years ago. The rate for children is not the same as adults, it is about half, and half of that are children who were not considered “overweight” before the definition changed in 2007, those in the 85-94th percentile. The 300,000 statistic was also debunked by the CDC (see Flegal et al., 2005) and found to be 26,000 instead – and in fact, the people who live the longest are in the “overweight” range. As for “costs of obesity,” the figure you state is tremendously inflated. Moreover, as long as we are practicing medicine by BMI-profiling, we will have wasted money spent on the 51% of the healthy people who are deemed “unhealthy” based on weight and the 18% unhealthy ones who are overlooked because their weight looks fine (see Wildman et al., 2008).

Please stop perpetuating the misinformation that adds to the stigma of higher-weight people.

Dr. Miller it’s concerning to say the least to see someone who is promoting “evidence based medicine” recycle a very old and repeatedly debunked piece of data.

300,000 people are not dying annually of “obesity”. That was completely debunked by Catherine Flegal at the NIH in 2005 – seven years ago. And when you carelessly repeat bad data *you are contributing to the stigma* that you say you are concerned about.

When Dr. Faulkner and the other folks at Resources for Living have data showing that their program has helped people keep a significant amount of weight off for (at a minimum) 2-5 years with not problematic iatrogenic side effects I’ll be very interested in a look at their work. Because that would be something new.